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When the midwifery pilot project started in Gander in 2019, many were hoping for the program's quick expansion.
COVID-19, however, has slowed down the process and pregnant moms outside of the Central Health region are still without midwives.
One of those people is Maggie Burton. The St. John's city councillor and mother of two is currently 37 weeks pregnant with her third child and doesn't have access to midwifery services.
Her second child, daughter Ursula, was delivered in a water birth in Burton's home in 2014 with a pre-legislation midwife by her side.
“It was just life-changing,” said Burton. “And I wish that other people could choose that if it's the right thing for them.”
Provincial midwifery regulations were implemented two years later. In 2020, the first registered midwives delivered babies in Gander, about a three-and-a-half-hour drive from St. John's.
Cara Begg-Reid, the chairperson of the College of Midwives of Newfoundland and Labrador (CMNL), says some mothers have travelled to Gander in the past year to access a midwife.
But Burton wonders how practical that is for a mother on the East Coast, like herself, with other children at home to care for.
After a "traumatic birth experience" with her first child, son Jack, in a hospital, she chose a midwife for her second pregnancy.
“It was very peaceful,” said Burton of Ursula's birth. “My labour was much easier than it was when I was at the hospital because I was more relaxed. So, for myself personally, that was just a much better experience.”
Deirdre Maguire wants everyone in the province to have this option. Maguire is the executive director of Birth Justice NL. The provincial consumer group, formed as Friends of Midwifery of NL in 1994, advocates for a speedy expansion of midwifery across the province.
“A lot of people just really want more choice. They want family-centred care, they want to have more of a say in how their birth goes,” said Maguire.
Maguire views midwifery as a needed addition to the good work of provincial obstetricians and nurses. While she understands that the process takes time, she criticizes the government's lack of communication and focus on midwifery.
“We got regulations five years ago, and most people in the province still don't have access to midwifery care,” said Maguire. “In the middle of a provincial election, none of the parties have even put this on their platform.”
And so, Burton and others have to give birth in the hospital. On top of that, current COVID-19 restrictions allow each birthing mother to be accompanied by only one support person.
Burton is sad she can't bring her doula, who was there for her second pregnancy.
“The fact that I can't bring both my partner and my doula is really upsetting to me because I really depend on her as a supporter of mine. So that sucks, basically,” she said.
“It's just a very different experience; it's not necessarily a worse one, but if I could have my doula there, I would be fine.”
The restrictions of having only one support person during birth doesn't apply to midwives, who are primary health care providers.
Brianna Thompson is president of the Association of Midwives of Newfoundland and Labrador (AMNL) and works as a registered midwife in Gander.
Especially during a pandemic, says Thompson, midwives are beneficial for taking a lot of stress off parents' shoulders.
“We see a lot of those benefits being highlighted now, especially with COVID, to not go into the hospital if you don't need to,” she said. “That's a really nice thing that only midwives can offer.”
Thompson says COVID-19 has been named as the main factor in the delay of the expansion of midwifery.
“As a province, we've been standing still for a bit,” said Thompson. “The explanation often is COVID, but I mean, midwifery was regulated in 2016, and we didn't actually have midwives until 2019, so it's definitely taken a long time to get off the ground.”
Begg-Reid agrees the process could be sped up but understands the obstacles COVID-19 has presented.
“I can't blame the government for that, or the hospitals, because COVID has had such an impact. I'm certainly happy with the commitment that the government has shown,” she said.
The AMNL is giving presentations to Health Accord NL to discuss the future of provincial midwifery services. Maguire and Thompson both emphasize that midwifery is a good economic decision. Not only is it cost-effective, but it can also help keep rural birthing centres open, a factor essential for people living in remote areas.
Burton would like to see services implemented quickly, so everyone giving birth in the province has a choice, just like she did back in 2014.
“The province should capitalize on the success from the Gander pilot project and just try to roll out midwifery province-wide as fast as they can because I don't see why not,” she said.